Evaluating the feasibility of ReWork-SCI: a person-centred intervention for return-to-work after spinal cord injury

Abstract

ObjectivesTo evaluate the feasibility of: (1) ReWork-SCI with regard to adherence and acceptability and (2) a study design for evaluating ReWork-SCI with regard to recruitment, retention and outcome measures.DesignPre-test and post-test, single group, feasibility study.SettingSpinal cord injury (SCI) unit at a regional rehabilitation centre in Sweden.ParticipantsTwo women and five men (n=7). Eligible criteria: (1) sustained traumatic or non-traumatic SCI; (2) completed the first acute care episode in a hospital; (3) between 18 to 65 years of age; (4) assessed by a physician as approachable for participation in the intervention; (5) history of permanent or temporary employment; (6) self-reported desire to return to work; and (7) ability to communicate in English or Swedish.InterventionReWork-SCI is a person-centred intervention for return-to-work (RTW), developed and evaluated using the Medical Research Council’s guidelines. ReWork-SCI follows a person-centred, structured and coordinated intervention process led by a coordinator within a SCI rehabilitation team.Outcome measuresThe feasibility of ReWork-SCI and a study design was evaluated using a set of outcome measurement tools, vocational data, logbooks and semi-structured interviews.ResultsAll eligible participants accepted enrolment and follow-up. All participants had a plan for RTW after 3 months and four participants had initiated part-time work or work trial 6 months after commencement of intervention. Adherence and acceptability were overall good. Challenges of the intervention related to the person-centred follow-up, staff shortage and rootedness in the SCI team.ConclusionsReWork-SCI was feasible and can contribute to a systematic design of an individualised plan, facilitate decision-making and build trust in the RTW process after SCI. Core features of the intervention was the systematic structure, use of a person-centred approach and dialogue with the employer. For the effectiveness of ReWork-SCI, modifications and considerations of study design are needed.

Return to work after COVID-19: Experiences and expectations from the first wave of COVID-19 in Stockholm

“…A practical implication of this study is that, when planning RTW for all these groups, authorities should provide support for coordinating the different health efforts and systems that are required. This means that a coordinator or health professional that could conduct follow-ups and coordination meetings is needed as argued in other Swedish RTW studies [1,39,42]. Another implication is that employers need to have a more comprehensive understanding of this group, since this study illustrates that experienced challenges related to work can be individual and can change over time.…”

“…This dilemma is known from other studies in which RTW has been explored from the perspective of i.e. persons with stroke [36][37][38], spinal cord injury [1,35,39], cancer [40,41], and mental illness [42]. Common for all these groups in a Swedish context, has been the challenge of coordinating the different health system and insurance requirements as well as receiving timely and relevant support.…”

Stakeholders’ Expectations of Return-to-Work After Spinal Cord Injury: A 1-Year Follow-Up

“…These work-related expectations reflect social norms of work that tend to frame the RTW process as "coming back as before," preferably full-time (Social Insurance, 2020). In this study, persons with SCI had participated in an intervention that emphasized timeliness and RTW as a gradual process in which uncertainties of everyday life and work were sorted in a dialogue between stakeholders (Holmlund, Guidetti, Hultling, et al, 2020). Yet the findings show that persons with SCI, who returned to paid part-time work, experienced expectations that were perceived as having little consideration of feelings of readiness or balance with other meaningful occupations (e.g., self-care, taking care of children, among others).…”

“…The present study is part of a larger and interdisciplinary project investigating RTW for adults with SCI to develop and evaluate the design and feasibility of a complex intervention that can serve as a complement to current RTW practices in Sweden. The development and feasibility of the RTW intervention for adults with SCI are described in detail elsewhere (Holmlund, Guidetti, Hultling, et al, 2020). The project received ethical approval from the Regional Ethical Review Board in Stockholm, Sweden.…”

“…Occupational science scholarship regarding RTW has mainly focused on the aspects that facilitate or hinder the employment of people with disabilities, the relationship between barriers to entry to employment and concepts such as occupational injustice and occupational adaptation (e.g., Jakobsen, 2004, 2009; Soeker, 2011). In turn, the occupational therapy literature has focused on intervention studies of RTW after discharge from rehabilitation settings (e.g., Holmlund, Guidetti, Eriksson, & Asaba, 2020; Holmlund, Guidetti, Hultling, et al, 2020; Öst-Nilsson et al, 2017). Although these studies have provided valuable insights into the profession, they have focused either on practice implications or on theoretical conceptualizations of RTW.…”